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For several weeks my schedule has gotten the best of me and all efforts at working out have fallen by the wayside. So, I decided to think about fitness, motivation and the “MED” (minimum exercise dose) to maintain fitness. Here’s what I came up with:

1. Consistency, not quantity is essential.

10-20 minutes “every” day (i.e. 5 or 6 days a week) is really better than 60 minutes once a week. Google “ten minute workouts” and you’ll find a huge number of workouts to do (or buy).

Concentrate on just increasing the time you move. Consider using a pedometer (cheap) or one of the more expensive monitors, like the Apple Watch.

There are a lot of people around all of us who somehow figure out how to stay fit with the same busy schedule that we have. Somehow they make it a high enough priority to “just do it”. It’s doable, so our excuses are just that… excuses. (Darn)

There’s no question that fitting exercise into a busy schedule is hard. But there are a lot of reasons that the time is worth it. Of all the things you can do for yourself as a medical student, resident or practicing physician, staying fit has to be at the top of the list. It’s not only essential for your physical health, it’s one of the most effective ways to reduce stress.

It’s important to look for exercise that’s fun. The last thing you need is to put exercise on the scut list. One option that you might think about, if you haven’t tried it, is spinning. Spinning is basically a great cardio workout done to music with other people. So, you not only get your heart rate up, you can destress with loud music in the company of people you don’t work with!

Spinning is a workout on a special stationary bicycle, usually at a fitness or spin center. Unlike regular stationary bikes, spin bikes have a heavy fly wheel and the design is closer to a road (or racing) bicycle. There are no gears – you control how hard you are working by turning a knob to adjust the resistance (i.e. you control how hard it is to pedal). This means you have control over how hard you are working.

Spinning is most often done as a group class (although there is no reason you couldn’t use the bicycle on your own when there is no class going on). The class leader (instructor) will be on a bike at the front of the room, will choose the music and will guide the class.

How do I find a spin class?

Most big fitness centers will have spin classes, so the first place to look is a gym near you. Many gyms let you pay for spin classes without joining the gym. Some cities have spin centers i.e. a gym that only has spin classes. Use Google and see what you can find. If any of your friends are cyclists, they probably go to spin classes during the winter (in the north) or summer (in the south) to stay in shape, so you can ask them, too.

What do I do to not look stupid the first time?

The first time you go to a spin class, it’s easy to be intimidated. There will be people there who do spin classes 2-4 times a week, are all decked out in bike gear and look like they could ride a bike up Mount Everest. Here’s the bottom line – they all had a first class, just like you. Secondly, the instructor (and most of the people there) will be happy you are there and learning. Finally, you don’t have to do all the moves – You can sit on a bike in the back of the class and just pedal – and no one will say anything.

When you find a class you’d like to try, call and ask if the instructor will meet with you for 5 minutes to explain how the bikes work and how to best adjust the seat and handlebars. Alternatively, show up 10 minutes early and ask the instructor to show you what to do.

You don’t need anything special for your first class, but you will need a towel and a bottle of water.

What “moves” will I see in the spin class?

In addition to just sitting and pedaling, the instructor will “simulate” a ride. For example, he/she may use a specific song during a “hill climb” – and will ask everyone to increase the resistance on the bike so it’s hard to pedal. They may also have you do “sprints” i.e. increase your cadence so you are pedaling really fast. The only other move you’ll see involves standing up to pedal. The first time I did a class I couldn’t do this at all (so don’t worry if the same is true for you). It will come with time as your quads get stronger.

Should I buy any equipment?

Initially, no. You can do a spin class with regular gym clothes. A heart rate monitor is a good investment for any of your cardio exercise, but it’s particularly helpful for spinning.

If you end up liking spinning, you’ll want to buy a pair of good bike shorts. (They REALLY make a difference!) The pedals on spin bikes have both a toe cage (to use with regular running or workout shoes) and a clip (for bike shoes). When you use the cage or the clip, you secure your foot to the pedal, which allows you to pull up as well as push down. If you become a real fan of spinning, you may want to buy biking shoes, but make sure the cleats are “SPD” which is what is used on almost all spin bikes.

To maintain your fitness (and to be able to eat without gaining weight) it’s best to shoot for a minimum of 3-4 cardio workouts a week. To be effective, the workouts should be 30 minutes or longer. But – consistency is more important than intensity. If all you have is 10 minutes, then do one of these 10 minute workouts or go for a fast 10 minute walk in the hospital. If you can do three separate 10 minute workouts in a day, it is just as effective (at least for maintenance of fitness) as a 30 minute session.

Some people have incredible discipline about this (and the rest of us hate them.) For mere mortals who basically have to really work at this, you have to have a different strategy….

The first thing you have to do is choose what kind of cardio you want to do. The trick here is feeling like you are playing, not working. Dancing counts… so does jumping rope. You have to look for fun ways to exercise

For many people, music is the difference between feeling like you are playing during a workout vs. working. Use music to create your own “Fartlek” workout. Fartlek workouts are also called “speed play” – the idea is to incorporate random intervals of speed work into your workout so you don’t just plod along at the same rate. One way to do this is to put your music on a random shuffle, or find a good (and free) music source that you can stream. Change your speed and intensity based on the song, or part of the song you are listening to. If the song is slow, decrease your speed (but increase the resistance if you are on a machine). If the song is fast, move with it – increase your effort (e.g sprint if you are running) to keep in time with the music.

Have fun! Go out and play!

Internet music sites:

http://www.pandora.com– internet radio that lets you design your own radio stations or choose from a large selection

I hate running. Whew.. that’s out of the way. BUT – I have been a runner in the past, I live with a runner, and it’s absolutely clear to me that running is the ideal cardio exercise for medical students and residents. So, I’m going to try to convince you that you should incorporate running – even in a very small amount – into your daily routine .

Why Running is Perfect for Medical Students and Residents

It’s cheap. Other than an good pair of running shoes (and don’t buy less than good ones), there is no expense.

It’s portable. A bag with your shoes, shirt and shorts can stay in the trunk of your car.

It’s social. Once you identify a friend or two who agree it’s a good idea to run, you can do it together.

It’s efficient. Short runs are still a great workout. Unlike other workouts which require planning, travel and time to complete, you can walk out the front door and run.

It’s empowering. You can set goals and easily accomplish them. There are a lot of times during your training that you will feel things are out of your control. Setting a goal (I’m going to run a mile) and then doing it (Yeah!) is empowering.

It does more than just get you fit. There are good data that show that exercise in general (and running in particular) decreases stress, improves depression, helps sleep, etc. etc.

How to get started

This month’s Runner’s World (May 2010) is a guide for beginners. I really recommend you pick it up. (I’ll list a few websites below, too) Here are the key concepts on how to get started running:

Don’t do too much to start with. Start with walking and add in small amounts of running. “Every able-bodied person can be a runner,” says Gordon Bakoulis, a running coach based in New York City, :Just start slowly and build up gradually.” (Runner’s World May 2010, p 68)

Be consistent. Your goal is to exercise every day. Cardio is an important part of your exercise, but not all of it. You can run every day, but you’ll have to find time to do resistance and flexibility training as well. Alternatively, you can view resistance days as “recovery” from running i.e. alternate the days. Commit to some kind of exercise everyday. Plan your week to make sure you get at least 3-4 cardio sessions/week – and then cut yourself some slack if something happens that pushes you off track. It’s human nature – if you say you are going to run every day, you’ll probably run 4 or 5 times. But, if you say you’ll run 3 times a week, it will probably end up being only once. (For more information see the entry from April 3, 2010 – “Exercise for Medical Students and Residents”)

Read, ask questions, learn about this skill. Every city has a “runner’s store” (which is different from a store than sells running shoes). Ask the runner’s in your class where they go to buy their shoes. The store will have shoes, but it will also have very knowledgeable people who will be delighted to help you learn about running.

I know you don’t want to hear this, but early morning is the best time to run. It’s an energizing way to start the day, you “get it out of the way”, and you don’t have to fight the siren song of the couch at the end of a long day. If you do choose to run at the end of the day, change into your clothes before you leave school or the hospital and run before you get home. If you have willpower of iron you might be able to lace up the shoes and run before you go to sleep … if it works for you, great! (but it won’t for most people) .

Think about signing up for a fund raising group. Running for kids with cancer makes you feel pretty silly about whining….

Register for a 5K race – having a goal to finish (and getting your first time) will be motivating

“Gratitude is contagious.” Kristen Armstrong, in this month’s Runner’s World, suggests that instead of feeling like you “have” to run that you think about what a gift it is that you “get” to run. “If you view your run as an opportunity, your attitude will get an adjustment”.

One of the great fallacies about working out is that you need to “go somewhere” to work out. This idea that working out is separate from the rest of your life is the main reason people don’t work out. Be creative – there are lots of ways to work out that don’t require much and can be done in the hospital. There are days on call and then there are days on call (everyone who has done it knows what I am talking about). On the days that have a little “breathing room” here are some ways to work out while you are at work.

Cardio options

Take the stairs instead of the elevator. There are good data that 3 sessions of 10 minutes of cardio has the same result as a 30 minute cardio session. Those 2-3 minute “sessions” of going from floor to floor will add up to 20-30 minutes easily by the end of the day. Or, if you want to push it a bit, add a few flights (or minutes) here and there. You can always find 10 minutes (or 20, if the day permits) and really climb the stairs.

Take a jump rope to the hospital and keep it in the call room

Find out if there is a stress test lab or PT area in the hospital that has stationary bikes or treadmills that you can use.

Go for a walk. If it’s safe, and your beeper and cell phone permit, walk outside the hospital. If not, do “power rounds” on the floors for exercise (do the circuit of each floor, climb the stairs to the next floor and continue).

Talk your program into paying for a used bike or treadmill.

Commute to work on your feet or on a bicycle (more on that later…)

Strength training options

Buy a set of stretch bands or inflatable (with water) dumbbells and throw them into your on-call bag. You can get a good strength training workout with these.

Cheap dumbbells are easy to find. For $20-30, you can put a pair or two in the call room or resident lounge. See if there are other residents that want to go in with you to buy a complete set. Of course, you will have to find a way to lock them up if, like most hospitals, things have a habit of walking away.

Old fashion calesthenics (push-ups, squats, etc) will provide a good strength workout , too. You might consider one of the many popular DVD based programs that are making the rounds (no pun intended) at the moment.

Flexibility training

Stretching can be done anywhere, anytime. Like weight training, there are some good tips that can be taught by a pro. Make sure if you hire a personal trainer that you ask them to give you some tips about stretching, too. There are also excellent books on stretching. You might think about web based or DVD yoga sessions as another alternative.

The key concept here is that working out during call is doable – and will often help with fatigue, stress and the feeling of being overworked. These “workouts” don’t have to be long – even 10 minutes will help.

There is no question that there are many people who have integrated exercise into their daily routine so successfully that they don’t even think about it. It becomes part of their day, just like brushing their teeth, or putting on their pants in the morning. But even though it seems like the majority of people around you are in this category, it’s just not true. There are the real exceptions – like the guy who gets up at 4 every morning (even if he went to sleep at 2) to run. If you have never been an “athlete” you may feel really intimidated by these people. .

The benefits of exercise during your training can’t be overestimated.

It’s the right thing to do. Physicians do physical as well as intellectual work. You are taking care of people’s families. It doesn’t surprise you that policemen, firemen, astronauts and soldiers have physical fitness as a requirement. It’s no different for us. .

You will have a life after training. In your 20s and 30s, you may be able to get away with not being active, but those years of inactivity will be paid for later.

You will feel better physically. You will have more energy.

You will feel better emotionally. There is a direct effect of working out (stress reduction), but there is also the psychological benefit of taking care of yourself.

Consistency, not intensity is the key

One of the biggest mistakes you can make is to view working out as something that you do as an activity “outside” of your day. A 45 minute work out, plus the time to get to the gym, plus showering and changing can easily take an hour and a half. For many residents, that kind of time commitment is a luxury they can’t afford. So, we have great intentions to get to the gym 3 times a week… and next thing you know, a month has gone by with no trips to the gym at all. One of the ways to improve consistency is to have a list of a variety of things to choose from. Although it’s expensive in most cities, a gym membership will help. See if it can’t be part of your holiday “wish list” for your family. The other thing that should be on that list, by the way, is a maid once a week to do your laundry and clean your house. Unless, of course, you want to use housecleaning as one of your calorie burning activities!

It’s a skill, and there are teachers

Most people know about cardiovascular training and have probably run, swam, or biked at some point in their life. The nice thing about running, swimming and biking is that everyone can do them, often at any time of the day, and it doesn’t take a lot of money, or a gym membership to do. But there are other options for cardiovascular fitness that you can explore – spinning classes, martial arts training, aerobics classes – when these are offered at gyms, there will always be a teacher to help you learn.

Even though the emphasis is often on cardiovascular training alone, fitness is a composite of cardiovascular, strength and flexibility training. If you’ve never participated in team sports, and haven’t had a reason to be in a gym, there is a good chance you don’t know the basics about weight training. You are not alone, and it’s normal to feel a bit intimidated. You can find a fellow resident to show you, but, often they haven’t learned proper form, either. It’s better to have a pro show you. If you join a gym, there are several options. Many gyms have circuit classes using free weights – which is a great combination of cardiovascular and strength training. There are also personal trainers. Although you probably won’t want to spend the money for a trainer on a regular basis, you can hire one for 2 or 3 sessions to teach you about each of the machines, and help you plan a workout routine or two.

Unfortunately, morning is usually the best time to work out

There are a few people who, no matter how tired they are can get to the gym, or go for a run after work. If your day started at 5 or 6 and is ending after 5 or 6 (or 7 or 8 or…), most people are just too tired and the call of the couch is too strong to go workout. In general, the most consistent exercisers usually get it done first thing in the morning. For most medical students morning will usually work. As you enter your residency, you are going to have to be more flexible.

Different days = different workouts

Call days are tough… and, for exercise, the day after call is the toughest of all. The key here is consistency. On the post-call day, don’t plan for long workout at the gym, but do plan for a 20 minute brisk walk when you get home. If there is a way to have someone cover you for 30 minutes before morning rounds, go for an early morning run outside, or climb the stairs in the hospital for 20 minutes. Don’t forget to plan in a day or two of rest, every week. It’s tempting to use the post-call day for your recovery and that may be the best thing some weeks. However, recovery from call is easier if it includes some working out.